Ground-breaking change to the mental health section of the WHO Model List of Essential Medicines: implications for low- and middle-income countries

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Essential medicines for mental disorders: comparison of 121 national lists with WHO recommendations

Abstract Background To compare the medicines for mental disorders included in national essential medicines lists with the World Health Organization (WHO) essential medicines list and assess the extent to which economic status and WHO Region account for the differences. Methods We searched WHO repository and government sites for national essential medicines lists and we abstracted medicines for mental disorders. We calculated the proportion of WHO essential medicines included, the total number of differences (counting both additions and deletions) between national and WHO model list and the proportion of lists including one second-generation oral antipsychotic plus one new-generation antidepressant. Non-parametric statistics was used to investigate whether these indicators were dependent on economic status and WHO Region. Results Amongst the 121 identified national lists, the total number of medicines for mental disorders ranged from 2 to 63 (median: 18; IQR: 14 to 25). The median proportion of WHO essential medicines for mental disorders included was 86% (IQR: 71–93%), with 16 countries (13%, 95% CI 7.75–20.5%) including all WHO essential medicines, while the median number of differences with the WHO EML was 11 (IQR: 7 to 15). Country economic level was positively associated with both the proportion of WHO essential medicines included (Spearman's rho = 0.417, p < 0.001) and the number of differences (Spearman's rho = 0.345, p < 0.001), implying that countries with higher income level included more WHO essential medicines, but also more additional medicines. Significant differences were observed in relation to WHO Region, with the African and Western Pacific Region showing the lowest proportions of WHO essential medicines, and the European Region showing the highest median number of differences. Overall, 88 national lists (73%, 95% CI 63–80%) included at least one second-generation oral antipsychotic and new-generation antidepressant, with differences by income level and WHO Region. Conclusions The degree of alignment of national lists with the WHO model list is substantial, but there are considerable differences in relation to economic status and WHO Region. These findings may help decision-makers to identify opportunities to improve national lists, aiming to increase access to essential medicines for mental disorders

Updating the WHO Model Lists of Essential Medicines to promote global access to the most cost-effective and safe medicines for mental disorders

Since 1977, the WHO Model Lists of Essential Medicines (EML) have been a benchmark to guide the procurement of medicines at the national level, especially in low-income and middle-income countries. Aiming to include the most effective, safe, and cost-effective medicines for priority conditions, WHO updates the EML for adults and the EML for children every 2 years. Over the past 45 years, updates to the EML mental health section have been infrequent, in most cases with additions of individual medicines. A comprehensive revision of the entire section has never been attempted. With the aim of increasing the use of the WHO EML to expand the selection of the most effective and safe medicines for mental disorders, a series of evidence-based applications were submitted to the WHO Expert Committee on the Selection and Use of Essential Medicines in 2022, recommending a substantial revision of the entire mental health section. In this Health Policy, we summarise the recommended update and the evidence justifying it. We also discuss challenges in the update process, suggesting possible solutions. The requested comprehensive revision of the WHO EML mental health section aligns the list with the latest evidence. The revision offers an opportunity for countries to promote access to the most effective, safe, and cost-effective medicines for mental disorders, contributing to universal health coverage and global mental health equity

Analysis of sprint ski mountaineering performance

Ski mountaineering sprint competitions are short individual races involving 3 uphill sections (U), 3 transitions (T), and a final descent. To date, relatively little is known about this novel Olympic discipline, and here we examined (1)&nbsp;the contribution of the time spent on U, T, and final descent to overall finishing time and (2)&nbsp;the potential relationships with final ranking. During the different rounds of 2 International Ski Mountaineering Federation World Cup sprint competitions, male and female ski mountaineers were video recorded. Correlation and multiple linear regression analyses were used to investigate the impact of U, T, and final descent on the best overall finishing time. Linear-mixed model analysis was applied to explore potential interactions between section times, rounds, and final ranking. Overall, U (r = .90-.97) and T (r = .57-.89) were closely correlated with the best overall finishing time (all P &lt; .05). U explained approximately 80% to 90% of the variation in the best finishing time for both sexes, with U + T explaining approximately 95% to 98% of this variation. In each successive round, the ski mountaineers eliminated were all slower on U than the Top 3 (all P &lt; .05). The fastest skiers increased their performance on U in the later rounds of the competitions, while those eliminated showed a tendency toward a decrease. Our findings reveal that world-class sprint ski mountaineers conduct transitions optimally and perform effectively uphill. Training for such competitions should aim to improve short supramaximal uphill performance (∼1.5-2.5&nbsp;min), ensuring that this does not decline with multiple efforts. These insights into ski mountaineering sprint performance are of considerable value in connection with training for the 2026 Winter Olympics

Comparative genomics and population genetics provide new insights on the life cycle of the black truffle of Périgord (Tuber melanosporum Vittad.)

International audienceTruffles are ectomycorrhizal fungi living in symbiosis with many trees and shrubs. Inoculated seedlings with truffles are available since forty years and the interest in truffle cultivation is increasing worldwide. However, novel management guidelines for sustainable truffle orchards, in which the production is less unpredictable even in the climate change context, are needed. A better understanding of the biological and ecological mechanisms driving the truffle life cycle is one of the approaches to reach these goals. The genomic resources available for Tuber melanosporum allowed us to unravel its sexual reproduction mode by identifying mating type genes and to characterize new polymorphic markers allowing population genetics analyses. The study of genet distribution in truffle orchards showed a non-random spatial distribution of ectomycorrhizas formed by both T. melanosporum mating types, as well as a rapid yearly turnover of these genets. This analysis revealed a striking competition between genets based on their mating-type genes to colonize plant root system and questioned the localization of both parents in the initiation of the sexual cycle. To gain additional information on T. melanosporum genetic diversity, we re-sequenced the nuclear genome of six geographic accessions. A total of 442,326 single nucleotide polymorphisms (SNPs) corresponding to 3,540 SNPs/Mbps were identified. Based on their SNP density, samples clustered according to their geographic origin and the putative role of the last glaciation in T. melanosporum phylogeography is confirmed. Additionally, genomic regions and genes potentially subjected to positive or purifying selection were identified. Finally, a large-scale analysis of T. melanosporum populations at European scale using highly polymorphic simple sequence repeats (SSR) is also in progress

Comparative genomics and population genetics provide new insights on the life cycle of the black truffle of Périgord (Tuber melanosporum Vittad.)

International audienceTruffles are ectomycorrhizal fungi living in symbiosis with many trees and shrubs. Inoculated seedlings with truffles are available since forty years and the interest in truffle cultivation is increasing worldwide. However, novel management guidelines for sustainable truffle orchards, in which the production is less unpredictable even in the climate change context, are needed. A better understanding of the biological and ecological mechanisms driving the truffle life cycle is one of the approaches to reach these goals. The genomic resources available for Tuber melanosporum allowed us to unravel its sexual reproduction mode by identifying mating type genes and to characterize new polymorphic markers allowing population genetics analyses. The study of genet distribution in truffle orchards showed a non-random spatial distribution of ectomycorrhizas formed by both T. melanosporum mating types, as well as a rapid yearly turnover of these genets. This analysis revealed a striking competition between genets based on their mating-type genes to colonize plant root system and questioned the localization of both parents in the initiation of the sexual cycle. To gain additional information on T. melanosporum genetic diversity, we re-sequenced the nuclear genome of six geographic accessions. A total of 442,326 single nucleotide polymorphisms (SNPs) corresponding to 3,540 SNPs/Mbps were identified. Based on their SNP density, samples clustered according to their geographic origin and the putative role of the last glaciation in T. melanosporum phylogeography is confirmed. Additionally, genomic regions and genes potentially subjected to positive or purifying selection were identified. Finally, a large-scale analysis of T. melanosporum populations at European scale using highly polymorphic simple sequence repeats (SSR) is also in progress

Tolerability of vortioxetine compared to selective serotonin reuptake inhibitors in older adults with major depressive disorder (VESPA): a randomised, assessor-blinded and statistician-blinded, multicentre, superiority trialResearch in context

Summary: Background: Major depressive disorder (MDD) is prevalent and disabling among older adults. Standing on its tolerability profile, vortioxetine might be a promising alternative to selective serotonin reuptake inhibitors (SSRIs) in such a vulnerable population. Methods: We conducted a randomised, assessor- and statistician-blinded, superiority trial including older adults with MDD. The study was conducted between 02/02/2019 and 02/22/2023 in 11 Italian Psychiatric Services. Participants were randomised to vortioxetine or one of the SSRIs, selected according to common practice. Treatment discontinuation due to adverse events after six months was the primary outcome, for which we aimed to detect a 12% difference in favour of vortioxetine. The study was registered in the online repository clinicaltrials.gov (NCT03779789). Findings: The intention-to-treat population included 179 individuals randomised to vortioxetine and 178 to SSRIs. Mean age was 73.7 years (standard deviation 6.1), and 264 participants (69%) were female. Of those on vortioxetine, 78 (44%) discontinued the treatment due to adverse events at six months, compared to 59 (33%) of those on SSRIs (odds ratio 1.56; 95% confidence interval 1.01–2.39). Adjusted and per-protocol analyses confirmed point estimates in favour of SSRIs, but without a significant difference. With the exception of the unadjusted survival analysis showing SSRIs to outperform vortioxetine, secondary outcomes provided results consistent with a lack of substantial safety and tolerability differences between the two arms. Overall, no significant differences emerged in terms of response rates, depressive symptoms and quality of life, while SSRIs outperformed vortioxetine in terms of cognitive performance. Interpretation: As opposed to what was previously hypothesised, vortioxetine did not show a better tolerability profile compared to SSRIs in older adults with MDD in this study. Additionally, hypothetical advantages of vortioxetine on depression-related cognitive symptoms might be questioned. The study's statistical power and highly pragmatic design allow for generalisability to real-world practice. Funding: The study was funded by the Italian Medicines Agency within the “2016 Call for Independent Drug Research”